Neurologist Re-check #2

Today was Stella's 2nd check-up with the Neurologist - 2 months since her official corrected diagnosis: seizures secondary to immune-mediated encephalitis.

Blood was drawn again for routine bloodwork and once again we all anticipate everything will come back normal.

Dr. P has taken Stella off Prednisone.  She will remain on Levetiracetam 250mg tablets, 3x a day.

We noticed the other day that Stella's right ear was starting to droop lower than her left and her head was also slightly tilted.  Dr. P examined her ears and said she had a very slight ear infection (which we will tend to with our normal ear cleaning routine at home) but that he thinks the ear droop is just muscle or nerve related and doesn't think it's anything to worry about.  He also said the head tilt was not worrisome to him either and that "it just makes Stella look cuter"  :)

We were told Stella can resume vaccinations as scheduled but that she should not receive more than one vaccination at a time - they should be scheduled for different visits a few weeks apart.  Dr. P also said we should not give Stella heartworm preventative and flea preventative on the same day; again, spacing them a few weeks apart. 

Stella will have her next recheck in 4 months.

Neurologist Re-check #1

Stella had her follow-up visit with the Neurologist today.  We reported that the past 2 weeks have been great. Baby girl is back to her normal self :)

Dr. P drew some blood for routine bloodwork which we all anticipate will be normal.  He is also taking her Prednisone down to 5mg.  He has asked us to not vaccinate Stella at this time until she is given the "all clear" and he wants another re-check in 2 months.

We told Dr. P that we are trying to give Stella her pills as close to 8 hours as possible but due to our work schedules we have been giving them at 6:30am, 4pm and 9-10pm.  Dr. p said this was just fine.

The diagnosis on her discharge instructions reads: recheck for epilepsy secondary to immune-mediated encephalitis.


 
As I stated before I do not want to go into detail about what transpired with the first neurologist that caused the serious communication breakdown and I am glad that we stuck with our gut instinct and sought the second opinion, however seeing Stella today, 2 weeks later, and the fact that we came so close to doing the unthinkable makes me very emotional.  All we want is for Stella to have the best life that she can - the thought that it was almost cut short ......I can't even explain how heavy it makes my heart.

Meanwhile we celebrated Stella's 9th birthday last week!!!

Knee & Neck - I Forgot to mention......

In all the chaos from the past few months I forgot to mention that Stella's partial torn ACL (back left) does not appear to be bothering her anymore.  She is walking fine.  But because we know it's there we try to give her an "elevator" lift onto the couch and our bed as much as possible so she doesn't have to use the doggy stairs - man alive our pets are spoiled!! 

Also, that chicken dance jerking neck thing she did a few months ago while attempting to eat has not happened again.  Perhaps whatever issue she was having with her neck was minor and healed itself as the orthopedic surgeon stated it might.

Oh and that issue she had with not correcting her back right foot when it was flipped over seems to have corrected itself.

Let's hope the seizures work themselves out as well.

2nd Neurologist's Opinion

When we made this second-opinion appointment we were told not to feed Stella after midnight in case anesthesia was administered if the neurologist wanted to do an MRI.  We were also told to stop all medications after midnight.  Should Stella have a seizure during the night that we found alarming we were told to go to the emergency room.

Our appointment was in the late morning.  Stella skipping a dose of the Phenobarbital made her less catatonic and a little more steady on her feet.  When we met with the second neurologist, Dr. P, we explained all that that had transpired over the past 6 days.  We told him that if he agreed with the current diagnosis of idiopathic epilepsy and agreed that this current treatment plan was our only option that we would seriously have to consider doing the unthinkable.  Just typing these words makes me cry - but we had a long discussion about Stella’s quality of life and we could not bear to let her live out her life in this current state.

Dr. P, noticing how emotional we were, said “I know you’re worried, but don’t jump ahead, let’s take this one step at a time”.  He then sat back and listened to us intently all the while watching Stella’s manner and her every move.  At one point we noticed Stella had that same tremoring that she had been doing for days, as if she was really cold.  He watched her and said “those are seizures”.  So even with the powerful medication she was still having seizures and they were, alarmingly, more frequent - OMG.

Dr. P said the first thing he would like to do was to flush her system and rid her of the Phenobarbital as much as possible.  He wanted her to stay at the hospital while they slowly flushed her system through an IV.  Meanwhile he stated he wanted to look at the actual MRI images for himself.  We told him we would go to the other hospital and pick up a copy of the images on CD and bring them to his office for review – we agree to regroup in 3 hours. 

3 hours later we returned and Dr. P came into the room with a smile and said “you are going to be pleasantly surprised”.  He opened the door and in walked Stella – walking on her own!  She was not 100% but appeared to be at least 90% OUR STELLA!  We asked Dr. P what he did and he said all they did up to that point was flush her system.  He said neither he nor his staff witnessed and “major” seizures, just the smaller “trembling” kind - which he stated was not necessarily worrisome at this point.

After reviewing the MRI images and having spent the last few hours with Stella Dr. P said his opinion based on all details of the past week was that Stella did not have just Idiopathic Epilepsy.  He believes she has Idiopathic Encephalitis (inflammation of the brain of unknown origin) which is causing the seizures.  He believes she should be on a low dose anti-seizure medication.  He has prescribed Levetiracetam (Keppra) 250mg tablets for the seizures (half a pill 3x a day) and Prednisone 10mg tablets for the inflammation.

Dr. P wants a follow-up visit with Stella in two weeks.

We left the office feeling hopeful - Stella walked herself to the car!



 

 

 

My Opinion on Second Opinions

I just wanted to take a moment and throw in my two cents about seeking a second opinion.

I am a firm believer in educating oneself as much as possible when making decisions.  Not only doing as much research as possible but also seeking opinions from experts as well as from family and friends.  People will differ with their opinions but I find that helpful because different perspectives will give you insight into things you may not have even thought of and the more information you have the better the choices you can make, the less second guessing you will do and the less regrets you will hopefully have. 

Unlike with a home or a car many people seem to be apprehensive in seeking a second opinion when it involves a doctor, whether for themselves or their pet, because they worry about hurt feelings or insulting a professional.  They feel an awkwardness will ensue and relationships may be irrevocably broken.  My opinion is that true professionals will encourage you to make an informed choice.  If someone is insulted or offended by your desire for a second opinion you probably do not want to do business with them anyway.  Professionals should always want what is best for you or your pet and that should be the bottom line for everyone involved.  In my experience I find that if I seek a second opinion or sometimes multiple opinions, regardless if I agree with all or some or none of them, the more confident I feel about the choices I make. 

In Stella's case we would still need to bring her back to the specialty hospital to see the Oncologist so the fact that we may ultimately decide against having their Neurologist treat her may seem, to some, a potentially awkward situation.  To us, we are comfortable with the knowledge that we are dealing with professionals and do not anticipate that seeking a second opinion elsewhere would pose any problem.

I guess I'm just trying to say do whatever is necessary for you to feel good about your choices.  Educate yourself, write down and ask hard questions, but also know that often times there are no right or wrong answers and sometimes you just have to go with your gut instinct. 

And one last thing……..if you don’t like that last haircut you got (and paid for), go to someone else.  Don’t even think twice about hurting someone’s feelings – you’ll look ridiculous…..literally.

 

Follow-up with Neurologist - Seeking a Second Opinion

We are extremely upset and feel completely lost and broken.  Yesterday, it had been 5 days since Stella started on the powerful seizure medication (Phenobarbital).  We had waited all this time to finally speak with her Neurologist, which we understand was unavoidable and just bad timing.  Unfortunately we have had a serious communication breakdown with the Neurologist and the conversation we had with her last night has left us extremely uncomfortable.  We are very concerned about Stella’s current catatonic state and condition and we are now left wondering if she is on the right treatment plan.  I won’t go into details about our conversation with the Dr. C. but suffice it to say that we have decided that we need to seek a second opinion.

 

We have made an appointment for this Thursday, two days from now, with another Neurologist.  Incidentally this second Neurologist is one we have gone to before years ago with two of our other dogs.  When Stella started having seizures we felt it was important to keep all of her healthcare under one roof, at the specialty hospital, and at the beginning we did not know if the seizure activity was related to her cancer issues and wanted to be close by to her oncologist so we made the decision to see the Neuro at this same facility.  As I stated in a previous post – all the veterinarians contributing to her current health issue (Oncologist, Neurologist, our regular vet and the ER vets) all agree that this seizure activity is a completely unrelated to her cancer history.

For the next two days until we see the second Neurologist we will abide with the suggestion of the first Neuro that we reduce the Phenobarbital dosage to half her current dose.

We are hopeful that the second Neurologist can provide more clarity with Stella’s condition and can lead us on the right path….whatever that may be.

Meanwhile Stella's condition remains the same; very worrisome.

Seizure Treatment Plan - Day 7

Same as yesterday. Same alarming appearance and behavior.  Still catatonic but maybe just a tiny bit less being off the Gabapentin.  Still having those shivering bouts.

Appetite poor and we're still worried she may drown in the water bowl.  Still unable to walk properly,  still needing to be carried to the grass to relieve herself.

 

One more day until we can speak with the Neurologist......so worried......